Ovarian Reserve: Meaning, Diagnosis & Treatment
Ovarian reserve refers to the number and quality of remaining eggs in a woman´s ovaries and is a key indicator of female fertility and reproductive potential.
Things worth knowing about "Ovarian Reserve"
Ovarian reserve refers to the number and quality of remaining eggs in a woman´s ovaries and is a key indicator of female fertility and reproductive potential.
What Is Ovarian Reserve?
The term ovarian reserve refers to the quantity and quality of a woman´s remaining eggs (oocytes) stored within the ovaries. It is a central measure of reproductive capacity, indicating how many eggs are still available for potential fertilization and pregnancy. As a woman ages, her ovarian reserve naturally declines -- both in the number of eggs and in their quality.
Causes of Diminished Ovarian Reserve
A reduced ovarian reserve can result from various factors:
- Natural aging: Egg count declines more rapidly after age 35.
- Genetic factors: Family history of early menopause or chromosomal conditions such as Fragile X syndrome.
- Ovarian surgery: Previous procedures on the ovaries, for example to treat endometriosis or ovarian cysts, may damage ovarian tissue.
- Chemotherapy and radiation therapy: Cancer treatments can permanently impair ovarian function.
- Autoimmune conditions: Certain autoimmune processes may target ovarian tissue.
- Primary ovarian insufficiency (POI): Premature decline of ovarian function before the age of 40.
- Smoking: Nicotine accelerates the depletion of the follicular pool.
Symptoms and Signs
Diminished ovarian reserve often causes no obvious symptoms. Possible indicators may include:
- Difficulty conceiving despite regular unprotected intercourse
- Shortened or irregular menstrual cycles
- Absent or infrequent periods
- Hot flushes or other menopausal symptoms in younger women, which may suggest premature ovarian insufficiency
Diagnosis
Ovarian reserve is assessed using several diagnostic tools:
AMH (Anti-Mullerian Hormone)
Anti-Mullerian hormone (AMH) is produced by follicles in the ovaries and is considered the most reliable single marker of ovarian reserve. A low AMH level indicates a reduced egg count. This blood test can be performed on any day of the menstrual cycle.
AFC (Antral Follicle Count)
The antral follicle count (AFC) uses transvaginal ultrasound to count the small, resting follicles in both ovaries. A low AFC (fewer than 5 to 7 follicles per ovary) is considered a sign of reduced ovarian reserve.
FSH and Estradiol Levels
Follicle-stimulating hormone (FSH) is measured on day 2 or 3 of the menstrual cycle. An elevated FSH level may indicate diminished ovarian reserve. Estradiol is measured at the same time, as an elevated estradiol level can artificially suppress FSH values, masking a true increase.
Treatment and Options
Management depends on the degree of impairment and the patient´s individual fertility goals:
Assisted Reproductive Technologies
- Ovarian stimulation: As part of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), the ovaries are stimulated with hormones to retrieve available eggs.
- Egg freezing (oocyte cryopreservation): Elective freezing of a woman own eggs, ideally before the age of 35.
- Egg donation: When the ovarian reserve is severely depleted or exhausted, using donor eggs may be an option.
Lifestyle Modifications
- Quitting smoking
- Weight optimization
- Stress reduction
- A balanced diet rich in micronutrients such as folic acid, vitamin D, and coenzyme Q10
Hormonal Support
In cases of diagnosed primary ovarian insufficiency, hormone replacement therapy (HRT) may be prescribed to relieve symptoms of estrogen deficiency and protect bone health.
Relevance in Reproductive Medicine
Ovarian reserve is a critical parameter in fertility counseling and treatment planning. It influences the choice of treatment strategy, the expected response to ovarian stimulation, and the overall prognosis for assisted reproduction. Women who are trying to conceive should consider a fertility evaluation after 6 to 12 months of unsuccessful attempts -- or sooner if known risk factors are present.
References
- Broer SL et al. - AMH and AFC as predictors of excessive response, poor response and clinical pregnancy: a systematic review and meta-analysis. Human Reproduction Update, 2011.
- European Society of Human Reproduction and Embryology (ESHRE) - Guideline on the management of premature ovarian insufficiency (2016). Available at: https://www.eshre.eu
- La Marca A, Sighinolfi G et al. - Anti-Mullerian hormone (AMH) as a predictive marker in ART. Human Reproduction Update, 2010.
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